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This is VAERS ID 35089

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35089
VAERS Form:
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 297909 / 1 RL / -
HIBV: PEDVAXHIB / MSD 0173T / 1 LL / -
OPV: ORIMUNE / LEDERLE 0632C / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, VOMIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 12/8/2009

VAERS ID: 35089 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-10-02 1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 297909 / 1 RL / -
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0173T / 1 LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0632C / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: SIDS, Sudden infant death syndrome, Vomiting, VOMIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 5/14/2017

VAERS ID: 35089 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0632C / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 9/14/2017

VAERS ID: 35089 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 1 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 1 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 2/14/2018

VAERS ID: 35089 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 6/14/2018

VAERS ID: 35089 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 8/14/2018

VAERS ID: 35089 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 9/14/2018

VAERS ID: 35089 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;


Changed on 10/14/2018

VAERS ID: 35089 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:New Hampshire
Vaccinated:1991-06-17
Onset:1991-07-07
Submitted:1991-09-24
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-SIDS
CDC 'Split Type':

Write-up: spitting up day before death, no diarrhea, fever;

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